Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame

ABSTRACT

The present invention relates to a radially collapsible frame ( 1 ) for a prosthetic valve, the frame ( 1 ) comprising an outflow end region ( 3 ) at a proximal end of the frame ( 1 ) and an inflow end region ( 2 ) at a distal end of the frame ( 1 ), opposite to the outflow end region ( 3 ). The frame ( 1 ) further includes at least two radially spaced commissure attachment regions ( 10, 10′, 10 ″) and a cell structure ( 30 ), composed of a plurality of lattice cells being arranged radially around a flow axis of the frame ( 1 ) and connecting the at least two commissure attachment regions ( 10, 10′, 10 ″). Finally, at least one anchoring/positioning arch ( 20, 20′, 20 ″) is provided, wherein said at least one anchoring/positioning arch ( 20, 20′, 20 ″) radially overlaps the cell structure ( 30 ) at least partially. In order to form the inventive frame from as a single piece, the invention further relates to a method comprising bending the at least one anchoring/positioning arch ( 20, 20′, 20 ″) towards the cell structure ( 30 ) of the frame ( 1 ).

This application is a continuation of U.S. application Ser. No.15/834,376, filed on Dec. 7, 2017, which is a continuation of U.S.application Ser. No. 14/914,313, filed on Feb. 25, 2016, now U.S. Pat.No. 9,867,694, which is a U.S. national stage filing under 35 U.S.C. §371 of International Application No. PCT/EP2014/065817, filed on Jul.23, 2014, which claims the benefit of priority to European PatentApplication No. 13182346.0, filed on Aug. 30, 2013. Each of U.S.application Ser. Nos. 14/914,313 and 15/834,376, and InternationalApplication No. PCT/EP2014/065817, is incorporated by reference hereinin its entirety.

The present invention relates to a radially collapsible frame for aprosthetic heart valve and a method for manufacturing such a frame.Specifically, the present invention relates to a radially collapsibleframe for a prosthetic valve used in the treatment of a stenosis(narrowing) of a cardiac valve and/or a cardiac valve insufficiency. Inaddition, the present invention relates to an endoprosthesis comprisingthe inventive radially collapsible frame.

The expression “narrowing (stenosis) of a cardiac valve and/or cardiacvalve insufficiency” is intended to include a functional defect of oneor more cardiac valves which is either genetic or has developed. Acardiac defect of this type might affect each of the four heart valves,although the valves in the left ventricle (aortic and mitral valves) areaffected much more often than the right sided part of the heart(pulmonary and tricuspid valves). The functional defect can result innarrowing (stenosis), inability to close (insufficiency) or acombination of the two (combined vitium).

Radially collapsible frames for prosthetic heart valves are known in thestate of the art. In particular, minimally-invasive forms of treatmentof cardiac valves have been developed recently which are characterizedby allowing the procedure to be performed under local anesthesia. Oneapproach provides for the use of a catheter system to implant aself-expandable frame, which is connected to a collapsible valvularprosthesis. Such a self-expandable endoprosthesis can be guided via acatheter system to the implantation site within the heart through aninguinal artery or vein. After reaching the implantation site, theradially collapsible frame can be unfolded so as to anchor theendoprosthesis in the vicinity of a native valve annulus.

To this end, it is known that the radially collapsible frame may becomprised of, for example, a plurality of self-expanding substantiallylongitudinal arches, the arches being configured to hold a valvularprosthesis in place at the desired implantation site. The prior artdocument EP 1 980 220 A1, for instance, discloses a self-expandablestent having three retaining arms (20) which form the base for ananchoring segment for accommodating a valvular prosthesis (40). In orderto automatically position and orientate the common frame described bythe EP 1 980 220 A1, a total of three positioning arches (10) areprovided. The positioning arches (10) have a rounded head portion (12)which engages the pockets of an insufficient heart valve, which shall bereplaced by the known endoprosthesis. These three positioning arches(10) ensure that the requisite positioning accuracy can be obtained inthe direction of rotation and provide for additional radial clampingforces in order to support the implantation of the stent at the desiredimplantation side.

Additionally, when the known frame (1) is in its expanded state, therespective positioning arms of the positioning arches (10) are locatedin the pockets of the diseased heart valve and thus essentiallyguarantee secure and error-free positioning of the medical device. Thepocket flaps of the diseased heart valve are then clamped between thepositioning arches (10) and the retaining arches (20), in a mannersimilar to a paper-clip, due to the expansion of the endoprosthesis 1.This further assists in achieving an optimum positioning and anchoringof the known heart valve frame.

As a consequence of the clamping effect between the positioning arches(10) and the retaining arches (20), the radially collapsible framesknown from the prior art tend to allow for a frictional contact betweenthe valvular prosthesis and the diseased native heart valves, as thevalvular prosthesis is frequently directly connected to the retainingarches of the collapsible frame. Such a frictional contact between thediseased heart valve and the valvular prosthesis can result in increasedwear of the valvular prosthesis, due to undesired friction with thediseased heart valve. Furthermore, due to the common frameconfiguration, the diseased heart valve may impede the motion of thevalvular prosthesis, especially during the opening movement of theprosthetic valve leaflet. In some circumstances, this may mean that theprosthetic heart valve leaflets may not be able to open fully, as aconsequence of the presence of the diseased heart valve leaflets.Moreover, the common stent structures often fail to provide forsufficient radial forces in order to anchor the stent structure at thedesired implantation side. As a consequence, inadvertent relocation ofthe stent after implantation may occur.

On the basis of the problems outlined above, certain embodiments of thepresent invention address the issue of providing a radially collapsibleframe for a prosthetic valve, which guarantees perfect positioning ofthe heart valve prosthesis and, at the same time, protects theprosthetic valvular leaflets effectively from external stresses due to africtional contact with the native heart valve leaflets. In addition,the inventive frame should provide for a treatment of the narrowedcardiac valve or cardiac valve insufficiency by way of a simple andreliable procedure to enable a routine treatment without major stress tothe patient.

In this regard, and as it will be described in more detail below, theinvention provides a radially collapsible frame for a prosthetic heartvalve comprising an outflow region at a proximal end of the frame and aninflow end region at a distal end of the frame, opposite to the outflowend region. The radially collapsible frame further includes at least tworadially spaced commissure attachment regions located at the outflow endof the frame and being configured to receive commissures of theprosthetic valve leaflets. A cell structure composed of a plurality oflattice cells is being arranged radially around a flow axis of the frameand connects the at least two commissure attachment regions. Finally,the radially collapsible frame further comprises at least oneanchoring/positioning arch, wherein said at least oneanchoring/positioning arch radially overlaps the cell structure, atleast partially.

In medical terms, the commissure of a heart valve is a point or line ofunion or junction between the respective leaflets of a heart valve. Inthe closed state of a heart valve, the commissures can be described asthe points or lines of a leaflet, contacting another leaflet in order toclose the particular blood vessel. Naturally, the leaflets of a heartvalve are continuously in contact with each other at two or morecommissure edges which are radially distributed about the flow axis of aprosthetic heart valve. In this connection, the expression “commissureattachment region” describes an arrangement of struts located at theoutflow end of the inventive stent, which is configured to receive theat least two commissure edges of the leaflets. Normally, the number ofcommissure attachment regions complies with the number of commissureedges formed by the leaflets.

Furthermore, the term “radially overlapping” expresses that the at leastone anchoring/positioning arch is located along the same section of theframes flow axis as the cell structure. The anchoring/or positioningarch is, however, not part of the cell structure but radially distancedtherefrom. In particular, the at least one anchoring/positioning archmay extend radially outwardly from the circumference of the cellstructure, and hence, overlap the latter at least partly.

Accordingly, the inventive frame has the advantage that a cellstructure, which is composed of a plurality of lattice cells, preventsany undesired contact between the native heart valve leaflets and thevalvular prosthesis. In particular, the cell structure is disposedbetween the valvular prosthesis and the leaflets of the native valve.Therefore, the cell structure forms a separation wall in between and,additionally, provides for an improved clamping effect of the nativeheart valve leaflets together with the at least oneanchoring/positioning arch. Moreover, the inventive collapsible framedoes not necessarily have to provide for retaining arches, as it isconceivable to attach the valvular prosthesis directly to the pluralityof lattice cells of the cell structure, by means of threads for example.Finally, it should be noted that the cell structure provides for anadditional support of the inventive frame at the desired implantationside.

According to another embodiment of the present invention, the at leastone anchoring/positioning arch of the collapsible frame may be rigidlyattached to the at least two radially spaced commissure attachmentregions. In particular, it is preferred to form the at leastanchoring/positioning arch integrally with the at least two radiallyspaced commissure attachment regions as a single piece. In this way, theinventive radially collapsible frame is particularly robust and providesfor a stable support of the valvular prosthesis within a patient's bloodvessel. As it will be described in more detail below, all of the partsof the inventive frame may be cut out of a single hollow tube of shapememory material. Consequently, the radially overlapping at least oneanchoring/positioning arch does not need to be fixed to the collapsibleframe, by means of sutures, welding or adhesive, after the radiallyspaced commissure attachment regions and the cell structure have beencut out of the hollow metal tube. Instead, the at least oneanchoring/positioning arch is cut out of the same hollow tube as therest of the radially collapsible frame, wherein the at least oneanchoring/positioning arch is formed proximally of the outflow endregion of the frame and bend in a distal direction (towards the inflowend), so as to radially overlap the cell structure, after a lasercutting has been performed.

Of course, it is also feasible to apply other means of attaching theanchoring/positioning arch rigidly to the frame, such as welding,sewing, gluing or riveting for instance. According to this alternative,the at least one anchoring/positioning arch is formed as separate pieceand attached to the frame structure subsequently, after the frame hasbeen cut out of the hollow metal tube. In more detail, the at least oneseparate anchoring/positioning arch may be welded to the commissureattachment regions in such a way that the at least oneanchoring/positioning arch radially overlaps the cell structure at leastpartially and extends in a direction towards the in flow end of theframe. As a consequence, it is not necessary to bend the at least oneanchoring/position arch during a shape-setting process of the frame.

In accordance with another aspect of the present invention, theinventive frame further comprises a plurality of circumferentiallyarranged retaining arches, each including first and second arms joinedto one another at a distal end of the retaining arches. The two arms ofeach respective retaining arch are joined by a rounded structure. Theprovision of circumferentially arranged retaining arches provides forvarious advantages effects. In particular, the retaining arches, whichsubstantially range from the outflow end to the inflow end of theinventive frame, protrude radially in the expanded state of the frame topress against the wall of a patient's blood vessel in which the frame isdeployed with a radially-acting contact force. The shape of theretaining arches may be configured to be positioned below the nativevalve annulus or to be positioned at least on the native valve annulus,thereby providing additional anchoring for the inventive stent togetherwith a valvular prosthesis affixed thereto. As an alternative or inaddition to the cell structure of the frame, the retaining arches may beused in order to attach the valvular prosthesis to the collapsibleframe. In particular, a cusp edge of the valvular prosthesis may besutured to the retaining arches, at an opposite and of the freecommissure edges of the leaflets. In this connection, the first andsecond arms of each retaining arch may be shaped in such a way as toimitate the natural arcuate shape of the cusp edges of a native heartvalve.

To this end, the two arms of each retaining arch are joined to oneanother at a connection, preferably having a substantially U- orV-shaped structure. As mentioned before, this particular shape of theretaining arches may particularly imitate the natural shape of a heartvalve cusp region. The U- or V-shaped retaining arches may be located insuch a way that the closed portion of the U- or V-shape forms theconnection of the two arms in a distal direction, towards the inflow endof the frame. The open ends of the U- or V-shaped structure, on thecontrary, may be attached to the at least two commissure attachmentregions. Therefore, the retaining arches preferably have an open enddirected towards the outflow end of the radially collapsible frame.

According to another embodiment, an entirety of threeanchoring/positioning arches and an entirety of three retaining archesare provided at the inventive frame. Consequently, it is preferable tofurther provide for an entirety of three radially spaced commissureattachment regions, which are connected to the threeanchoring/positioning arches and the three retaining archesrespectively. In this regard, each first arm of the threeanchoring/positioning arches or retaining arches respectively may beconnected with a first commissure attachment region, whereas each secondarm may be attached to a second neighboring commissure attachmentregion. In this way, each anchoring position arch and each retainingarch is connected with at least two of the radially spaced commissureattachments of the frame. The provision of three retaining arches isparticularly useful when accommodating a valvular prosthesis havingthree flexible leaflets such as an aortic valve, for example. The sameapplies to the number of anchoring/positioning arches, which shouldcomply with the number of leaflets of the valvular prosthesis so as toguarantee a suitable orientation of each leaflet at the desiredimplantation site.

As already indicated, the adjacent arms of two neighboring retainingarches preferably merge at one of the commissure attachment regions,near the outflow end region of the frame. Accordingly, each of theretaining arches is connected to a neighboring retaining arch at one ofthe commissure attachment regions, forming a circumferentially alignedattachment region for the cusp edges of the valvular prosthesis.

In another embodiment, the cell structure of the frame comprises a firstcell region composed of a plurality of first cells, the first cellsbeing arranged between the respective first and second arms of eachretaining arch. Additionally, the cell structure may comprise a secondcell region composed of a plurality of second cells, the second cellsbeing arranged between adjacent arms of two neighboring retainingarches. In other words, the cell structure is preferably composed of atleast two different cell types, which are arranged in an alternatingmanner radially around a flow axis of the frame. The first and secondcell regions are intersected by the respective arms of the retainingarches. Preferably, the first and second cells of the first and secondcell regions are constructed with a similar pattern and size. However,it is also conceivable to construct the first and second cells withdifferently. In particular, it may be desirable to implement a densercell structure in the second cell region compared to the density of thecell structure in the first cell region. This is because the mainlysecond cell region provides for the stability of the inventive frame,whereas the first cell region is mainly provided in order to protect thevalvular prosthesis from any direct contact with the native heartvalves. Of course, however, the first cell region being arranged betweenthe respective first and second arms of each retaining arch, also addsto the stability of the present frame.

In a particularly preferred embodiment, the at least oneanchoring/positioning arch particularly radially overlaps the first cellregion of the cell structure. In other words, the at least oneanchoring/positioning arch is preferably arranged in between therespective first and second arms of each retaining arch, and thus,circumferentially aligned with the retaining arches.

According to another embodiment, each of the first cells or second cellsis formed by a plurality of struts. Accordingly, each of the struts iseither connected with one of the neighboring cells of the respectivecell regions or with one of the arms of the retaining archesrespectively. As already indicated above, each of the struts of thefirst and second cells is preferably formed by a laser cutting of ahollow shaped memory metal tube, providing for integrally connectedfirst and second cells of the frame structure.

As already indicated above, each of the positioning arches and each ofthe retaining arches include a closed end directed towards the inflowend of the frame, wherein the closed end of a respectiveanchoring/positioning arch is substantially circumferentially alignedwith respect to the closed end of an associated retaining arch. In otherwords, the positioning arches are configured symmetrically to theretaining arches although preferably disposed somewhat further towardsthe outflow region of the frame. Moreover, the upper end of thepositioning arches may be connected to the upper ends of the associatedretaining arches by means of the at least two radially space commissureattachment regions in the outflow region of the frame. In the expandedstate of the frame, both, the commissure attachment region and therespective upper end of the positioning and retaining arches spread outso that a radially-acting force is exerted on a blood vessel wall,thereby enabling secure anchoring of the stent at the site ofimplantation. The circumferentially aligned lower end of theanchoring/positioning arch, on the other hand, spreads out even furtherthan the retaining arches and the cell structure, so as to be able toengage the pockets of the native heart valve, thereby clamping thenative heart valve leaflets between the lower of the anchoring/positionarch and the lower end of the respective retaining arch.

In another embodiment, the present radially collapsible frame comprisesat least one fastening portion by means of which a valvular prosthesisis connected to the frame. The at least one fastening portion preferablyextends along the longitudinal axis of the frame and comprises aplurality of fastening holes distributed in a longitudinal direction ata discrete position along the length of the at least one fasteningportion. A thread of thin wire may be guided through each fastening holeto secure the valvular prosthesis to the stent. The advantage of thisfeature is that longitudinal displacement of the valvular relative tothe frame is a substantially minimized once implanted and so theprosthesis is not unduly disturbed or weakened as a result of the heartsperistaltic motion.

In addition to fastening holes, the fastening portion may include one ormore notches to assist the seating and retaining of suture material. Thenotches also assist with an even attachment of the prosthesis to theframe and similarly to the fastening holes, minimizing longitudinaldisplacement of the prosthesis. The fastening portions are preferablyformed as an integral part of the retaining arches. Nevertheless, it isalso conceivable to implement fastening portions along any of theremaining structures of the inventive frame, such as the commissureattachment regions.

According to another embodiment, the retaining arches have a shape thatmatches the leaflets of a prosthetic valve attached to the frame, in theexpanding state of the frame. This specific design of the respectivearms of the retaining arches is unique for catheter delivered valves asit provides for heart valve durability advantages. The so formed arms ofthe retaining arches for supporting the cusp edge of the leaflets of thevalvular prosthesis are attached to the frame across a gap behind thepositioning arches and the cell structure respectively.

In order to further increase the support of the frame at theimplantation site, the inventive frame may comprise at least one annularcollar which is connected to a part of the rounded structure at a distalend section of the respective arms of the retaining arches. That is, thelower end section of each arm of the retaining arches may merge into anannular collar, which provides an additional anchoring measure for theframe. Furthermore, the annular collar may also be connected to thelower end of the second cell region. The annular collar may exhibit aplurality of supporting webs which run parallel to the longitudinal axisof the fame in its collapsed state and are inter-connected bytransversal webs. In the expanded state of the frame, however, thesupporting webs and the transversal webs of the annular collar may forma rhomboid or serpentine-like annular collar which abuts against thevascular wall of the patient. Therefore, the annular collar serves asupporting body through which the radial forces developing due to theself-expansion are transmitted to the vascular wall. Since a relativelylarge contact area of the frame interacts with the vascular wall,because of the structure of the annular collar, there may be a decreasedrisk of injury to artery or the tissue despite the increased radialforces. Moreover, the annular collar may be used to attach a skirtportion of the valvular prosthesis to the inventive frame. In this way,the risk for paravalvular leakage can be substantially reduced.

Each of the supporting webs of the annular collar may further providefor an eyelet as an additional fastening means. In this regard, theeyelets are uniformly distributed around the inflow end section of theframe, thereby providing a more uniform fixation of a valvularprosthesis to the frame. Hence, the risk of an actual displacement ofthe valvular prosthesis relative to the frame may be reduced.

According to another aspect of the present invention, the lower endsection of the annular collar constitute at least one flared or taperedsection, in the expanded state of the frame, thereby providing for animproved fixation for the frame in the position of the native cardiacvalve and for preventing antegrade migration of the frame having avalvular prosthesis affixed thereto.

Preferably, the annular collar has a flared or tapered section with aradial shape. However, it is also conceivable that the flared or taperedsection is not uniform along the circumference of the frame. Forexample, the annular collar may have a flare only near the location ofthe positioning arches, wherein no flares are provided near thecommissure attachment regions, i.e. the regions in between the two armsof two neighboring position arches.

According to a most advantages embodiment, the annular collar maycomprise a flared and a tapered section at the same time. In particular,the upper end of the annular collar, which is connected to the lower endof the retaining arches and to the lower end of the second cell regionrespectively, may be flared, whereas the lower end of the annularcollar, which is located at the inflow end of the frame, may be tapered.In simple terms, the annular collar may have a substantially pear-shapedconfiguration, which effectively prevents damage to the patient's heartvessel caused by contact with the annular collar. If the present frameis used in order to support the implantation of a prosthetic aorticheart valve, for example, this specific configuration of the annularcollar is particularly advantageous. This is because the pear-shapedannular collar prevents the frame from irritating the heart conductionsystem by stimulating the bundle of his which is located below thenatural heart valve annulus, i.e. at the position where the annularcollar is supposed to be arranged. By forming the annular collar in apear-shape, it is possible to exclusively contact the lower region ofthe native heart valve annulus so as to support the inventive frame atthe implantation site. Any region further into the heart chamber, on theother hand, is not affected by the annular collar, as the lower endsection is tapered and hence does not contact the walls of the heartchamber at whole.

In another embodiment, the inventive frame has a scalloped inflow edgedesigned at its distal end when the frame is in its expanded state.Hence, the inflow edge of the frame does not lie entirely in the planeperpendicular to the longitudinal direction of the frame. Rather, theedge of the frame at its inflow end region may have a scalloped shape.In addition, the scalloped inflow edge may also be flared or taperedaround its circumference or only at the selected location. For example,one embodiment may include a flare at the inflow edge only near thelocation of the positioning arches and transition to a none-flaredstraight cylindrical shape in the area between two neighboringpositioning arches. In particular, the location of the respective flaresand the respective straight cylindrical shape may be determined by thelocation of the arms of the respective retaining arches to which thetissue component (s) of the valvular prosthesis is attached. Thescalloped shape generally follows the native valve annulus and does notcompromise the ability of the valve to seal against leakage.

As will be described in more detail below, when manufacturing theinventive frame, it is conceivable for the frame to exhibit a structureintegrally cut from a portion of a hollow tube, in particular from asmall metal tube, which incorporates all of the structures of the frameat the same time. Specifically, it is conceivable to use a laser beam tocut the stent structure from the small metal tube.

The small metal tube is most preferably a shape memory material suchthat the frame exhibits an integrally-formed structure which cantransform from a first pre-definable shape into a second pre-definableshape. Therefore, the frame exhibits a first pre-definable shape(collapsed shape) during insertion into the patient's body and a secondpre-definable shape (expanded shape) once it is implanted. Because ofthe frames design, during the transition of the frame from the firstpre-definable shape into the second pre-definable shape, the positioningarches and the cell structure radially expand as a function of thecross-sectional expansion of the frame. The frames second shape ispreferably selected such that when the frame is expanded, the cellstructure abuts against the wall of the blood vessel in which the frameis deployed. In addition, the lower ends of the cell structure which arepositioned beneath the native valve annulus, provide additionalanchoring of the stent.

When the frame consists of shaped memory material, the material ispreferably being designed such that the frame can transform from atemporary shape into a permanent shape under the influence of anexternal stimulus. In this regard, the temporary shape is the framesfirst shape (i.e. the collapsed state of the frame) while the permanentshape is assumed in the frames second shape (i.e. in the second state ofthe frame). In particular, the use of a shape memory material such asNitinol, i.e. an equiatomic alloy of nickel and titanium, allows for aparticularly gentle implantation procedure when implanting the frame.When manufacturing the frame from a shape memory material, the framestructure is preferably shaped after it has been cut into a stentpattern from a hollow tube. As will be described in more detail below,once the desired shape has been formed by bending the structures of theframe, this shape is “fixed”. This process is known as “programming”.Programming may be affected by heating the frame structure, forming theframe into the desired shape and then cooling the frame. Programming mayalso be affected by forming and shaping the frame structure at lowtemperatures, this being known as “cold stretching”. The permanent shapeis thus saved, enabling the frame to be stored and implanted in atemporary, non-formed shape. If an external stimulus then acts on thestents structure, the shape memory effect is activated and the savedpermanent shape is restored.

A particularly preferred embodiment provides for the external stimulusto be a definable switching temperature. It is thus conceivable that thestent material needs to be heated to a higher temperature than theswitching temperature in order to activate the shape memory effect andthus regenerate the saved permanent shape of the stent. A specificswitching temperature can be preset by the relevant selection of thechemical composition of the shape memory material and the heating timeduring programming.

It is particularly preferred to set the switching temperature to be inthe range of between room temperature and the patient's bodytemperature. Doing so is of advantage, especially with regard to themedical device being used as an implant in a patient's body.Accordingly, all that needs to be ensured when implanting the frame isthat the frame is warmed up to the patient's body temperature (37° C.)at the site of implementation so as to activate the shape memory effectof the frame material.

By means of the inventive frame, a diseased native heart valve may betreated. In this connection a prosthetic valve (valvular prosthesis) issupported on the inventive radially collapsible frame. Thereafter, theat least one anchoring/positioning arch is positioned within a pocket ofthe native heart valve. Subsequently, at least a portion of the nativeheart valve is positioned between the at least one anchoring/positioningarch and the plurality of cells of the cell structure. Finally, a radialforce is applied against a portion of the vascular wall, by means of thecommissure attachment region and the cell structure, for example, so asto fix the frame and the prosthetic valve to the desired implantationsite.

As already indicated before, the present invention further relates to anendoprosthesis comprising the inventive radially collapsible frame. Theendoprosthesis further includes a valvular prosthesis which is attachedto an inner surface of the frame, preferably by means of sutures. Theendoprosthesis may be used to treat any deficient heart valve, mostpreferably a deficient aortic heart valve. Due to the inventivestructure of the radially collapsible frame, the endoprosthesis can befixed securely to the native heart valve annulus and exhibits aparticularly high wear resistance.

For the majority of patients undergoing treatment, it is preferable forthe endoprosthesis to have an outer diameter of approximately 7.0 mm toapproximately 5.0 mm in its first shape so that the valvular prosthesiscan be introduced with a 23F delivery system (given an external diameterof 7.0 mm) or with a 17F delivery system (given an external diameter of5.0 mm).

Due to the new frame design, the inventive endoprosthesis can achieve anouter diameter between approximately 4.0 mm to approximately 8.0 mm inits first shape. Accordingly, the new endoprosthesis may be introducedwith a 20F delivery system, preferably an 18F delivery system, morepreferably a 16F delivery system and most preferably a 14F deliverysystem. Therefore, the endoprosthesis according to the present inventioncan be introduced into a patient's blood vessel easier and causes lessdamage.

After the endoprosthesis has been released from the catheter tip, in theimplanted state respectively, the endoprosthesis exhibits a secondpredefined shape in which the stent and the valve assembly affixedthereto is in an expanded state (expanded condition). Depending on thepatient being treated, it is preferable for the frame to exhibit adiameter of between 19.0 mm and 27.0 mm in its second shape andimplanted state.

The present invention further relates to a method for manufacturing aradially collapsible frame according to the present invention. Inparticular, the inventive method comprises a step for providing a hollowtube made of shaped memory material, followed by a step for scanning abeam of laser radiation over a desired region of the hollow tube, suchthat a desired pattern is cut into the tube, thereby cutting a stentpattern. In particular, the laser scanning step is configured in such away that the stent pattern comprises a basic frame cell structuredefining a mash, composed of a plurality of cells, each cell beingformed by a plurality of struts, and at least one anchoring/positioningarch extending away from the plurality of cells of the cell structure.In other words, by scanning the hollow tube with a beam of laserradiation, a stent pattern is cut out comprising a cell structure and atleast one anchoring/positioning arch located above the latter cellstructure.

Subsequently, in a shape setting process, the final structure of theradially collapsible frame is defined by bending the at least oneanchoring/positioning arch into the direction of the cell structure insuch a way that the at least one anchoring/positioning arch extends insubstantially the same direction as the plurality of cells of the cellstructure. Accordingly, the so bent at least one anchoring/positioningarch radially overlaps the plurality of cells of the cells structure atleast partially. As a consequence, the at least oneanchoring/positioning arch is radially distanced from the cell structureof the frame. That is, the at least one anchoring/positioning arch ispositioned in a radial distance from a flow axis of the frame, which isfurther than the cell structure.

In order to prevent the beam of laser radiation from cutting twoopposite ends of the hollow tube made of shaped memory material at thesame time, the step for scanning the metal tube with a beam of laserradiation may include a step for placing the hollow tube on a mandrel.Thus, after cutting one surface of the hollow tube, the beam of laserradiation hits the surface of the mandrel and hence does not affectanother opposite part of the hollow tube. In this connection, it shouldbe noted that the cut out stent pattern is removed from the mandrelbefore the aforementioned shape-setting process of the inventive methodis performed.

According to another embodiment of the present method, the shape settingprocess may apply a heat treatment process to the stent pattern. In moredetail, the heat treatment process can be used in order to set thepermanent shape of the frame to a shape with an at least partly radiallyoverlapping anchoring/positioning arch. Of course, the permanent shapeis configured to be the expanded shape of the inventive collapsibleframe. That is, in the temporary shape the frame is flexible and hencecan be collapsed in order to be introduced by an insertion device.

The following will make reference to the included drawings and describepreferred embodiments of the frame according to the present invention ingreater detail.

Shown are:

FIG. 1 a perspective side view of a first embodiment of the radiallycollapsible frame according to the present invention, capable ofsupporting and anchoring a valvular prosthesis, shown in its expandedstate;

FIG. 2 a second perspective side view of the frame according to thefirst embodiment shown in FIG. 1; and

FIG. 3 a flat roll-out view of a preferred embodiment of the cut outstent pattern, which can be used to manufacture a radially collapsibleframe in accordance with the present invention.

FIG. 4a a flat roll-out view of a cut out stent pattern withoutanchoring positioning arches, which can be used to manufacture aradially collapsible frame according to a second embodiment;

FIG. 4b a flat roll-out view of anchoring/positioning arches, which canbe used to manufacture a radially collapsible frame according to asecond embodiment;

FIG. 4c a flat roll-out view of a second embodiment of the inventiveframe, comprising the cut out stent pattern of FIG. 4a and theanchoring/positioning arches of FIG. 4 a;

FIG. 5 a flat roll-out view of a third embodiment of the inventiveradially collapsible frame.

FIGS. 1 and 2 show a first and second perspective view of a firstembodiment of a radially collapsible frame 1 in accordance with thepresent invention. In this connection, it should be noted that FIGS. 1and 2 respectively only show the depicted front half of the frameembodiment. In detail, the back half of the depicted frame whichincludes further commissure attachment regions and cell structures isnot depicted in order to ease the understanding of the presentinvention.

The first embodiment of the inventive radially collapsible frame 1depicted in FIGS. 1 and 2 comprises an outflow end region 3 at aproximal end of the frame and an inflow end region 2 at a distal end ofthe frame, opposite the outflow end region 3. If the present collapsibleframe 1 is used as a supporting structure for an aortic heart valvereplacement, for example, the outflow end region 3 is positioned towardsthe descending aorta, whereas the inflow end region 2 is located belowthe native valve annulus, that is, inside the left ventricle of thepatient's heart.

As can further be seen from FIGS. 1 and 2, the radially collapsibleframe further comprises at least two radially spaced commissure regions10, 10′, 10″ located at the outflow region 3 of the frame 1. In thedepicted embodiment the frame 1 comprises three radially spacedcommissure regions, only two of which are depicted due to the fact thatthe back half is omitted from the respective side views. The commissureattachment regions 10 comprise a commissure attachment portion 12 whichis configured to receive commissure edges of prosthetic valve leafletsof a valvular prosthesis. It should be noted that the valvularprosthesis is not shown in FIGS. 1 and 2 in order to improve thevisibility of the structures of the inventive collapsible frame. Inconnection with the attachment of the commissure edges of the prostheticvalve leaflets, the attention is drawn to U.S. Pat. No. 6,460,382 B1,which shows various options for attaching a leaflet to the respectivecommissure attachment regions.

At the proximal end of the commissure attachment regions 10, 10′, 10″,retaining portions 11, 11′, 11″ are provided. The retaining portions 11,11′, 11″ may comprise eyelets (not shown) which can be used in order totemporarily attach the inventive frame to a medical insertion device.Alternatively, the retaining portions could be received by grooves of aretaining element attached to the insertion device. The retainingportions 11, 11′, 11″ may comprise the depicted round shape. However, itis also conceivable to form the retaining portions 11, 11′, 11″ in anyother shape, such as rectangular or polygonal shapes.

The radially spaced commissure attachment regions 10, 10′, 10″ areconnected with each other by means of a cell structure 30 composed of aplurality of lattice cells 31, 31′, 31″, 32, 32′, 32″ which are arrangedradially around a flow axis (not shown) of the frame 1. The flow axis ofthe inventive frame is basically defined by the longitudinal axis of theframe, around which all of the depicted frame structures are disposedcircumferentially. As shown, the cell structure 30 is located beneaththe radially spaced commissure attachment regions 10, 10′, 10″ andattached with the lower end of the commissure attachment portions 12,12′, 12″. The commissure attachment portions 12, 12′, 12″ are designedso as to receive commissure edges of the leaflets of a valvularprosthesis. For this reason, the commissure attachment portions 12, 12′,12″ comprise a plurality of fastening holes (FIG. 3), providing a meansfor suturing the valvular prosthesis to the frame 1.

The cell structure 30 may be used in order to attach the cusp edges of avalvular prosthesis to the frame. In the depicted embodiment, however,the cell structure 30 functions in order to protect the leaflets of thevalvular prosthesis from any contact with the natural heart valveleaflets. In other words, the cell structure 30 may be used as a leafletguard as will be described in more detail below.

Further to the cell structure 30 and the radially spaced commissureattachment regions 10, 10′, 10″, the inventive frame comprises at leastone, in particular three, anchoring/positioning arches 20, 20′, 20″. Theanchoring/positioning arches 20, 20′, 20″ radially overlap the cellstructure 30 at least partially. In other words, theanchoring/positioning arches 20, 20′, 20″ are positioned at a radialdistance from the flow axis, which is further than the radial distanceof the cell structure 30 from the flow axis. That is, theanchoring/positioning arches 20, 20′, 20″ extend radially outwardsrelative to the cell structure 30.

Moreover, each of the positioning arches 20, 20′, 20″ comprises aneyelet 21, 21′, 21″ at a distal end thereof. The eyelets 21, 21′, 21″may be used in order to carry radiopaque markers (not shown) that helpwith introducing the inventive frame into a patient's blood vessel.

Each of the at least one anchoring/positioning arches 20, 20′, 20″ isrigidly attached to two neighboring commissure attachment regions 10,10′, 10″. According to the embodiment shown in FIGS. 1 and 2, theanchoring/positioning arches 20, 20′, 20″ are each formed integrallywith two of the radially spaced commissure attachment regions 10, 10′,10″ so as to form a single piece frame 1.

The first embodiment described by FIGS. 1 and 2 further comprises aplurality of circumferentially arranged retaining arches 40, 40′, 40″.Each of the retaining arches 40, 40′, 40″ comprises a first arm 40 a, 40a′, 40 a″ joined to a second arm 40 b, 40 b′, 40 b″ at a distal end ofthe retaining arches 40, 40′, 40″. The two arms 40 a, 40 a′, 40 a″, 40b, 40 b′, 40 b″ are joined by a rounded structure at the distal end,that is the direction of the inflow section 2 of the frame 1. It shouldbe noted, however, that the retaining arches are completely optional andmay be replaced by the cell structure 30 in further embodiments of thepresent invention. The retaining arches 40, 40′, 40″ provide for abetter support of the inventive frame 1 at the desired implantation siteand provide for an attachment region for the cusp edge of the leafletsof the valvular prosthesis. In more detail, the cusp edge of a valvularprosthesis can be sutured to the respective arms 40 a, 40 a′, 40 a″, 40b, 40 b′, 40 b″ of the retaining arches 40, 40′, 40″ by means of threadsor wires. In order to improve the attachment of the valvular prosthesiswith the arms 40 a, 40 a′, 40″, 40 b, 40 b′, 40 b″ of the retainingarches 40, 40′, 40″ each of the arms 40 a, 40 a′, 40 a″, 40 b, 40 b′, 40b″ may comprise a plurality of notches which are arranged substantiallyalong substantially the hole range of the retaining arches 40, 40′, 40″.The notches 41 may further assist the flexibility of the retainingarches 40, 40′, 40″ and hence the retaining arches 40, 40′, 40″ caneasily be adapted to the cusp edge of the prosthetic leaflets. Inaddition or as an alternative to the notches, the retaining arches 40,40′, 40″ may be provided with a plurality of fastening holes,distributed along the retaining arms 40 a, 40 a′, 40 a″, 40 b, 40 b′, 40b″.

Particularly shown in FIG. 1 is that the retaining arches 40, 40′, 40″are circumferentially aligned with the positioning arches 20, 20′, 20″.This is because the native valve leaflets are preferably clamped betweenthe positioning arches 20, 20′, 20″ and the retaining arches 40, 40′,40″ respectively. For the same reason, the retaining arches 40, 40′, 40″and the anchoring/positioning arches 20, 20′, 20″ have substantially thesame shape, preferably a substantially U- or V-shaped structure.

Adjacent arms of two neighboring retaining arches 40, 40′, 40″ orpositioning arches 20, 20′, 20″ merge at one of the commissureattachment regions 10, 10′, 10″, near the outflow end region 3 of theframe. Therefore, the retaining arches 40, 40′, 40″ and the positioningarches 20, 20′, 20″ are connected to each other near the outflow endregion 3, particularly via the commissure attachment portions 12, 12′,12″ of the commissure attachment regions 10, 10′, 10″.

As already mentioned above, the first and second arms 40 a, 40 a′, 40a″, 40 b, 40 b′, 40 b″ of the retaining arches 40, 40′, 40″ intersectthe cell structure 30 of the frame 1 according to the first embodiment.Due to this, the cell structure 30 comprises a first cell region 31composed of a plurality of first cells, arranged between the respectivefirst and second arms 40 a, 40 b, 40 a′, 40 b′, 40 a″, 40 b″ of eachretaining arch 40, 40′, 40″ and a second cell region 32, composed of aplurality of second cells. In contrast to the first cells of the firstcell region 31, the second cells of the second cell region 32 arearranged between adjacent arms of two neighboring retaining arches 40,40′, 40″. One example of the second cells 32, 32′, 32″ can be derivedfrom the perspective side view of FIG. 2. In this regard, the secondcell region 32 is located between the first arm 40 a of the firstretaining arch 40 and the second arm 40 b″ of the third retaining arch40″.

Each of the first cells and/or second cells of the first and second cellregion 31, 31′, 31″, 32, 32′, 32″ is formed by a plurality of struts311, 321 which are connected with retaining arches 40, 40′, 40″ or eachother respectively such that an onion-shaped cell structure is formed.The density of the first cell region 31, 31′, 31″ is substantially equalto the density of the second cell region 32, 32′, 32″. Alternatively, itis also feasible to manufacture the frame 1 with first and second cellregions 31, 31′, 31″, 32, 32′, 32″ having different cell densities. Inthis regard, it is most preferable to construct the cell regions 31,31′, 31″ in such a way that the density of the second cell region 32,32′, 32″ is denser than the density of the first cell region 31, 31′,31″.

The first and second cell regions 31, 31′, 31″ and 32, 32′, 32″respectively have different functions in the depicted embodiment. Thesecond cell region 32, 32′, 32″, on the one hand, provides for therequisite annular stability of the frame 1. The first cell region 31,31′, 31″, which is arranged between the two arms 40 a, 40 a′, 40 a″, 40b, 40 b′, 40 b″ of each respective retaining arm 40, 40′, 40″, on theother hand, is configured as a leaflet guard. That is, the first cell31, 31′, 31″ region mainly stops the native heart valve leaflets fromcontacting the leaflets of the valvular prosthesis which can be attachedto the inside of the frame 1. Of course, the first cell regions 31, 31′,31″ also provides for some stability of the inventive frame 1.

FIGS. 1 to 3 further show that the inventive frame 1 may have at leastone annular collar 50, which is connected to a lower part of the roundedstructure, at the distal end section of each of the retaining arches 40,40′, 40″. The annular collar 50 provides for an additional support ofthe frame 1 at the desired implantation site. In addition to theconnection with the retaining arms 40, 40′, 40″ the annular collar 50 isconnected to each or a few of the lower cells of the second cell region32, 32′, 32″, which are arranged between adjacent arms 40 a, 40 a′, 40a″, 40 b, 40 b′, 40 b″ of two neighboring retaining arches 40, 40′, 40″.

The annular collar 50 may constitute at least one flared and/or taperedsection of the frame for improving fixation of the frame 1 in theposition of the diseased valve of the patient and for preventingantegrade migration of the frame having a prosthetic valve affixedthereto. The embodiment shown in FIGS. 1 and 2 particularly shows thatthe struts 51 of the annular collar 50 are flared outwardly, so as toconstitute a flared section of the frame 1. Another preferredalternative, however, is to construct the annular collar 50 in asubstantial pear-shape. In more detail, the pear-shape is represented bya flared upper portion of the annular collar 50, which is connected tothe cell structure 30 and the retaining arches 40, 40′, 40″respectively, and a lower tapered section, which forms the inflow end 2of the frame 1. In this way, the inflow end 2 of the frame 1 providesthe stability of a flared section and is tapered inwardly in order toprevent forth stimulation of the nerves of the heart conduction system.

The particular flared and/or tapered shape of the annular collar 50 ispreferably only visible in the expanded state of the frame 1, as can bederived from a comparison of FIGS. 2 and 3. Preferably, the flared ortapered section of the frame has a circular shape. However, according toanther embodiment, the annular collar 50 may only have flared or taperedsections provided near the location of the retaining arches and noflared or tapered sections near the regions in between the two arms ofneighboring retaining arches 40, 40′, 40″. The annular collar 50 shownin FIGS. 1 and 2 is constructed of a plurality of struts formed in arhomboidal shape.

FIG. 3 is a flat roll out view of the frame 1 according to theembodiment depicted in FIGS. 1 and 2. From FIG. 3 it is readily apparentthat the frame 1 preferably exhibits a structure, which is integrallycut from a portion of a tube, in particular from a small metal tube. Thesmall metal tube is preferably made of a shape memory material such asNitinol. Of course, other shape memory materials are equivalentlyfeasibly. FIG. 3 shows the flat roll out view of the frame 1 in itsfirst collapsed mode. Of course, when the frame 1 is being introducedinto the patient's body, it is transferred to its second expanded mode,which is illustrated by FIGS. 1 and 2. That is, the frame consists of ashape memory material such that the frame can transform from a temporaryshape into a permanent shape under influence of an external stimulus.The temporary shape of the frame corresponds to the first compressedmode of the frame 1 (FIG. 3) and the permanent shape of the framecorresponds to the second expanded mode of the frame 1 (FIGS. 1 and 2).

The external stimulus can be a definable switching temperate bridge,which is preferably in the range of between room temperature and bodytemperature of the patient, so as to enable the frame 1 to expand assoon as the frame 1 gets in contact with the blood of the patient.

The present invention further relates to a method for manufacturing theradially collapsible frame 1. This method shall be described in moredetail with reference to FIG. 3. Firstly a hollow tube made of shapememory material is provided and cut into the stent pattern shown in FIG.3 by scanning a beam of laser radiation over the desired regions of thehollow tube. The cut out stent pattern of FIG. 3 shows a particularlyimportant aspect, namely that the positioning arches 20, 20′, 20″ areformed above the cell structure 30, the commissure attachment regions10, 10′, 10″ and the retaining arches 40, 40′, 40″ during the step forlaser cutting. This is because, otherwise the positioning arches 20,20′, 20″ could not be produced at the same time as the first cell region31, 31′, 31″ of the cell structure 30.

After cutting the stent pattern by means of laser radiation, ashape-setting process is carried out in order to rearrange the directionof the anchoring/positioning arches 20, 20′, 20″. In this way, the finalstructure of the radially collapsible frame 1, shown in FIGS. 1 and 2can be produced from a single piece of hollow tube. The shape-settingprocess includes a step for bending the anchoring/positioning arches 20,20′, 20″ such that the at least one anchoring/positioning arch 20, 20′,20″ extends in the same direction as the plurality of cells of the cellstructure 30 or the retaining arches 40, 40′, 40″ respectively. In thedepicted embodiment, the shape-setting process comprises a step forbending the anchoring/positioning arches 20, 20′, 20″ downward towardsthe inflow end 2 of the frame 1.

Bending the anchoring/positioning arches 20, 20′, 20″ downward towardsthe inflow 2 of the inventive frame may be implemented by applying aheat treatment process to the stent pattern. To this end, the stentpattern shown in FIG. 3 is deformed and fixed into the desired shapeshown in FIGS. 1 and 2 of the present invention. Subsequently, theshaped stent pattern is heated to temperatures between 400° and 600° C.for several minutes and rapidly cooled down via water quenching or bymeans of rapid air cooling, for example. In this way, the frame 1obtains a permanent mode, which is represented by FIGS. 1 and 2 of thepresent invention, and a temporary mode, which relates to the collapsedmode of the frame. Depending on the time and temperature of the heattreatment, the switching temperature between the temporary and thepermanent mode of the frame 1 can be adjusted. According to the presentinvention, it is preferred to set the shifting temperature to atemperature between room temperature and body temperature of thepatient, preferably about 22° C.

A second embodiment of the inventive radially collapsible frame can bederived from FIGS. 4a to 4c . The radially collapsible frame 100according to the second embodiment is shown in a flat roll-out view inFIG. 4c . Similar to the first embodiment, the second embodiment of theinventive radially collapsible frame 100 comprises an outflow end region103 at a proximal end of the frame 100 and inflow end region 102 at adistal end of the frame 100, opposite the outflow end region 103. Thedepicted radially collapsible frame 100 further comprises at least tworadially space commissure region 110, 110′, 110″ located at the out flowend region 103 of the frame 100. In particular, the depicted frame 100comprises three commissure regions 110, 110′, 110″. The commissureattachment regions 110, 110′, 110″ each comprise a commissure attachmentportion 112, 112′, 112″ which is configured to receive commissure edgesof prosthetic valve leaflet of a valve prosthesis.

The radially commissure attachment regions 110, 110′, 110″ are connectedto each other by means of a cell structure which is composed of aplurality of lattice cells which are arranged around a flow axis (notshown) of the frame 100. As shown, the cell structure 130 is locatedbetween the radially spaced attachment regions 110, 110′, 110″ andattached with the lower end of the commissure attachment portions 112,112′, 112″. The commissure attachment portions 112, 112′, 112″ comprisea plurality of fastening holes 113, providing a means for suturing thevalvular prosthesis to frame 100. According to the second embodiment,the retaining portions 111, 111′, 111″ are not directly attached to thecommissure attachment regions 110, 110′, 110″. Instead, as will bedescribed in more detail below, the retaining portions 111, 111′, 111″are attached to the anchoring/positioning arches 120, 120′, 120″ of thesecond embodiment.

Unlike the first embodiment, the inventive frame 100 according to thesecond embodiment does not comprise any retaining arches. For thisreason, the cell structure 130 is used in order to attach the cusp edgesof a valvular prosthesis to the frame 100. At the same time, the cellstructure 130 of the second embodiment functions in order to protect theleaflets of the valvular prosthesis from any contact with the naturalheart valve leaflets. That is, the cell structure 130 may be used as anattachment means and as a leaflet guard at the same time.

Further to the cell structure 130 and the radially spaced commissureattachment regions 110, 110′, 110″, the inventive frame 100 comprises atleast one, in particular three, anchoring/positioning arches 120, 120′,120″. The anchoring/positioning arches 120, 120′, 120″ radially overlapthe cell structure 30 at least partially. In other words, theanchoring/positioning arches 120, 120′, 120″ are positioned at a radialdistance at a flow axis, which is further than the radial distance ofthe cell structure 130 from the flow axis. That is, theanchoring/positioning arches 120, 120′, 120″ expand radially outwardsrelative to the cell structure 130. Each of the three anchoring/positionarches 120, 120′, 120″ comprises two arms 120 a, 120 b, 120 a′, 120 b′,120 a″, 120 b″ which are connected to each other at the inflow end 102of the frame 100. In general, the anchoring/positioning arches exhibitthe same features as the anchoring/positioning arches according to thefirst embodiment of the frame.

In contrast to the first embodiment, however, the positioning arches120, 120′, 120″ of the second embodiment are not integrally formedtogether with the rest of the stent frame, such as the cell structure130 and the commissure attachment region 110, 110′, 110″, shown in FIG.4a . Rather, the anchoring/positioning arches 120, 120′, 120″ aremanufactured as a separate piece, a roll-out view of which is shown inFIG. 4b . After producing the stent pattern of FIG. 4a and theanchoring/positioning arches 120, 120′, 120″ of FIG. 4b separately, thetwo parts are connected by means of welding, suturing, gluing orriveting. As can be derived from FIG. 4b , the anchoring/positioningarches 120, 120′, 120″ are most preferably welded to the edges of thecommissure attachment regions 110, 110′, 110″ of the frame 100 accordingto second embodiment.

At the proximal end of the anchoring/positioning arches 120, 120′, 120″,retaining portions 111, 111′, 111″ are provided. The retaining portions111, 111′, 111″ may comprise eyelets (not shown) which can be used inorder to temporarily attach the inventive frame 100 to a medicalinsertion device. Alternatively, the retaining portions 111, 111′, 111″could be received by grooves of a retaining element attached to theinsertion device. The retaining portions 111, 111′, 111″ may comprisethe depicted round shape. However, it is also conceivable to form theretaining portions 111, 111′, 111″ in any other shape, such asrectangular or polygonal shapes.

In order to manufacture the radially collapsible frame 100 of the secondembodiment, it is not necessary to bend the anchoring/positioning arches120, 120′, 120″ downward in a shape-setting process, after the stentpattern has been cut out of a hollow tube. Rather, theanchoring/positioning arches 120, 120′, 120″ are produced individuallyand attached in a separate manufacturing process step. This alternativemanufacturing method has the advantage that no bending processes areintroduced into the anchoring/positioning arches 120, 120′, 120″ duringthe shape setting process.

Finally it should be noted that the inventive frame 100 according to thesecond embodiment does not comprise a particular annular collar.Instead, the second embodiment of the inventive collapsible frame 100comprises three additional support structures 140, 140′, 140″ as can bederived from FIGS. 4a and c . The additional support structures 140,140′, 140″ are located at the inflow end region 102 of the radiallycollapsible frame 100 according to the second embodiment. Each of thethree additional structures 140, 140′, 140″ is attached to a lower endof one of the plurality of the respective cells of the cell structure130. Preferably, the additional support structure 140, 140′, 140″ aredisposed radially around a flow axis of the frame 100 with an angle ofabout 120° in between two of the additional support structures 140,140′, 140″. Furthermore, it can be derived from FIGS. 4a and 4c that theadditional support structures 140, 140′, 140″ comprise a small roundedshape, so as to contact small areas of the heart valve ventricle belowthe natural heart valve annulus. Furthermore, the additional supportstructures 140, 140′, 140″ are preferably flared outward so as toachieve an effect, similar to the effect of the annular collar 40.

A third embodiment of the inventive radially collapsible frame is shownin FIG. 5. In more detail, FIG. 5 shows a flat roll-out view of thethird embodiment of the inventive frame 200. The radially collapsibleframe 200 according to the third embodiment mostly corresponds to theradially collapsible frame 100 of the second embodiment. The maindifference between the frame 100 of the second embodiment and the frame200 of the third embodiment is the construction of the cell structure240. Unless stated otherwise, the parts of the frame 200 according tothe third embodiment correspond identically to the parts of the frame100 of the second embodiment. Similar parts were denoted with thereference signs of the second embodiment, wherein the factor “100” wasadded.

Compared to the cell structure 130 of the second embodiment, the cellstructure 230 of the third embodiment comprises a smaller amount oflattice cells in the longitudinal direction of frame 200. In particular,the third embodiment shown in FIG. 5 does not comprise the uppermost rowof cells of the cell structure 130 shown in FIG. 4c . Consequently, theframe 200 of the third embodiment has a smaller cell structure 130 whichis compensated by a plurality of commissure attachment arms 215 a, 215b, 215 a′, 215 b′, 215 a″, 215 b″. The commissure attachment arms 215 a,215 b, 215 a′, 215 b′, 215 a″, 215 b″ are part of the commissureattachment regions 210, 210′, 210″ and configured to attach thecommissure attachment portions 212, 112′, 212′ to the upper end of thecell structure 230. In particular, each of the commissure attachmentportions 212, 212′, 212″ is attached to the cell structure 230 by meansof two respective commissure attachment arms 215 a, 215 b, 215 a′, 215b′, 215 a″, 215 b″.

Each of the commissure attachment arms 215 a, 215 b, 215 a′, 215 b′, 215a″, 215 b″ comprises a plurality of notches 241, which have already beendescribed with respect to the embodiment shown in FIGS. 1 to 3. Similarto the arms of the retaining arches according to the first embodiment,the commissure attachment arms 215 a, 215 b, 215 a′, 215 b′, 215 a″, 215b″ are configured to assist with attaching the cusp edges of a valvularprosthesis to the collapsible frame 200. In particular, the cusp edgesof the valvular prosthesis may be sutured to the notches 241 of thecommissure attachment arches 215 a, 215 b, 215 a′, 215 b′, 215 a″, 215b″.

All above mentioned and described embodiments and preferred embodimentswill be appreciated by the skilled person to be workable also in othercombinations of the features not explicitly described and suchcombinations will also be within the scope and disclosure of theinvention. In particular, the frame of the first embodiment onlyoptionally comprises retaining arches as depicted by the figures.Similar to the second and third embodiment, these retaining arches couldbe completely replaced by the cell structure, which could be used inorder to attach the valvular prosthesis. Furthermore, the inventiveframe could comprise more or fewer flared or tapered portions in itslongitudinal direction. Finally, it should be noted that the frame isnot restricted to the shape memory material Nitinol. Of course, anyother suitable shape memory material is feasible especially in view ofthe bending stresses during the manufacturing as described above.

LIST OF REFERENCES

-   1, 100, 200 collapsible frame-   2, 102, 202 inflow end region-   3, 103, 203 outflow end region-   10, 10′, 10″ commissure attachment regions-   110, 110′, 110″-   210, 210′, 210″-   11, 11′, 11″ retaining portions-   111, 111′, 111″-   211, 211′, 211″-   12, 12′, 12″ commissure attachment portion-   112, 112′, 112″-   212, 212′, 212″-   20, 20′, 20″ anchoring/positioning arch-   120, 120′, 120″-   20, 220′, 220″-   20 a, 20 a′, 20 a″ first arm of anchoring/positioning arch-   120 a, 120 a′, 120 a″-   220 a, 220 a′, 220 a″-   20 b, 20 b′, 20 b″ second arm of anchoring/positioning arch-   120 b, 120 b′, 120 b″-   220 b, 220 b′, 220 b″-   21, 121, 221 eyelet of positioning arches-   30, 130, 230 cell structure-   31, 31′, 31″ first cell region-   32, 32′, 32″ second cell region-   40, 40′, 40″ retaining arch-   40 a, 40 a′, 40 a″ first arm of retaining arch-   40 b, 40 b′, 40 b″ second arm of retaining arch-   41, 241 notches-   50 annular collar-   51 struts of annular collar-   113 fastening holes-   140, 140′, 140″ additional support structure-   240, 240′, 240″-   215 a, 215 a′, 215 a″ first commissure attachment arm-   215 b, 215 b′, 215 b″ second commissure attachment arm-   311 struts of first cell region-   321 struts of second cell region

The invention claimed is:
 1. An endoprosthesis comprising: a frameincluding: at least two commissure regions at an outflow end region ofthe frame; a plurality of first arches, each first arch including afirst arm joined to a second arm; a plurality of second arches; andlattice cells proximal to an outflow end of each first arch and eachsecond arch, the lattice cells comprising a plurality of first cellsbetween the first arm and the second arm of each first arch, and aplurality of second cells between adjacent first arches, wherein theplurality of second arches is radially outward of at least a portion ofthe plurality of first cells; and a valve prosthesis coupled to theframe.
 2. The endoprosthesis of claim 1, wherein the frame includesthree commissure regions.
 3. The endoprosthesis of claim 1, wherein theframe includes three first arches and three second arches.
 4. Theendoprosthesis of claim 1, wherein the plurality of first cells isintegrally connected to the plurality of second cells.
 5. Theendoprosthesis of claim 1, wherein the first arm and the second arm ofeach first arch are joined to one another forming a U-shaped or V-shapedstructure.
 6. The endoprosthesis of claim 1, wherein a first arch joinsan adjacent first arch at one of the at least two commissure regions. 7.The endoprosthesis of claim 1, wherein each of the first arches and eachof the second arches has a closed end, and the closed end of each firstarch is circumferentially aligned with the closed end of a correspondingsecond arch.
 8. The endoprosthesis of claim 1, wherein at least onefirst arch of the plurality of first arches includes aperturesconfigured to receive a suture.
 9. An endoprosthesis comprising: a frameincluding: three commissure regions at an outflow end region of theframe; a plurality of first arches, each first arch including a firstarm joined to a second arm in a U-shaped or V-shaped structure; aplurality of second arches; and lattice cells comprising a plurality offirst cells between the first arm and the second arm of each first arch,and a plurality of second cells between adjacent first arches; and avalve prosthesis coupled to the frame; wherein at least one second archof the plurality of second arches is radially outward of at least aportion of the plurality of first cells and circumferentially alignedwith one of the first arches.
 10. The endoprosthesis of claim 9, whereinthe plurality of second arches includes exactly three second arches. 11.The endoprosthesis of claim 9, wherein the valve prosthesis is attachedto an inner surf ace of the frame via sutures.
 12. The endoprosthesis ofclaim 9, wherein the endoprosthesis has a compressed configuration andan expanded configuration, and an outer diameter of the endoprosthesisin the compressed configuration ranges from 5.0 mm to 7.0 mm.
 13. Theendoprosthesis of claim 9, wherein the frame includes an annular collarat an inflow end region of the frame.
 14. The endoprosthesis of claim 9,wherein the lattice cells are integrally connected to the plurality offirst arches and the plurality of second arches.
 15. An endoprosthesiscomprising: a frame having a compressed configuration and an expandedconfiguration, the frame including: three commissure regions at anoutflow end region of the frame; three first arches, each first archincluding a first arm joined to a second arm; three second arches; andlattice cells comprising a plurality of first cells between the firstarm and the second arm of each first arch, and a plurality of secondcells between adjacent first arches; and a valve prosthesis coupled toan inner surface of the frame; wherein each first arch and each secondarch has a closed end, and the closed end of each first arch iscircumferentially aligned with the closed end of a corresponding secondarch.
 16. The endoprosthesis of claim 15, wherein an outer diameter ofthe frame in the compressed configuration ranges from 5.0 mm to 7.0 mm.17. The endoprosthesis of claim 15, wherein the frame includes anannular collar at an inflow end region of the frame.
 18. Theendoprosthesis of claim 15, wherein each first arch joins an adjacentfirst arch at one of the three commissure regions.
 19. Theendoprosthesis of claim 15, wherein at least one second arch is radiallyoutward of at least a portion of the plurality of first cells.
 20. Theendoprosthesis of claim 15, wherein at least one first arch includesapertures.